Differential Outcomes of Indication-Specific Coronary Artery Bypass Grafting in Acute Type A Aortic Dissection

This study aimed to analyse how different indications for coronary artery bypass grafting (CABG) impact early mortality and long-term outcomes in patients with acute type A aortic dissection at a single high-volume centre. Between 2010 and 2018, patients diagnosed with acute type A aortic dissection who underwent emergency surgical repair at Fuwai Hospital were included. Patients were categorized by presence of concomitant CABG. Within this group, patients were further stratified by indication: coronary artery dissection, coronary artery disease (CAD), and heart failure after declamping (HFD). A total of 972 patients (mean age 47 years) were included. The 30-day mortality was significantly higher in the CABG group [18/119 (15.1%) vs 48/853 (5.6%); P < .001], with rates of 8.1% (5/62) for coronary artery dissection, 5.7% (2/35) for CAD, and 50% (11/22) for HFD. Multivariable logistic regression analysis revealed that bypass grafting for HFD increased 30-day mortality (odds ratio, 3.90; 95% confidence interval, 1.07-14.22). Overall, 10-year survival was 82.0%. Landmark analysis revealed that HFD patients had non-inferior late survival compared to other subgroups, whereas patients with CAD exhibited the lowest late survival rate (P = .002). CABG for HFD significantly increases the risk of 30-day mortality but not long-term mortality. Bypass grafting for CAD does not affect 30-day mortality but decreases long-term survival beyond this period compared to patients without bypass grafting.